Increased sensitivity to warfarin after heart valve replacement

The Annals of Pharmacotherapy
Mesbah RahmanEric G Butchart

Abstract

The dosage requirement of warfarin to achieve a given international normalized ratio (INR) often varies considerably between the immediate postoperative period and long-term follow-up in patients with prosthetic heart valves, leading to INR instability. To document the extent of warfarin sensitivity in a prospective study of patients receiving heart valve replacements. Clinical and laboratory data regarding anticoagulation for 111 patients who received warfarin following heart valve replacement were collected during their hospital stay (induction period) and between 1 and 3 months after surgery (follow-up period). Mean patient age was 65.39 +/- 10.55 years (range 29-85), with 66 men. The mean INR value during the follow-up period was, on average, 0.21 higher than the induction period (2.81 +/- 0.5 vs 2.6 +/- 0.6; p = 0.007). The mean follow-up warfarin dose was 1.54 mg higher than the mean induction warfarin dose (5.09 +/- 2.03 vs 3.55 +/- 1.94 mg; p < 0.001). The warfarin dose index, which indicates relative sensitivity of warfarin, decreased from 1.16 to 0.65 (p < 0.001). Although the INR values during the induction and follow-up periods were similar, the dose requirement in the follow-up period was, on average, 43% higher th...Continue Reading

References

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Citations

Mar 28, 2007·Blood·Eric A MillicanBrian F Gage
Dec 9, 2008·Clinics in Laboratory Medicine·Marjorie Bon HommeMark W Linder
Jan 22, 2008·Journal of Internal Medicine·S SchulmanM Zondag
Mar 27, 2007·Pharmacotherapy·William E DagerMaureen A Smythe
Jul 29, 2016·The Annals of Pharmacotherapy·Douglas D DeCarolisThomas S Rector
Nov 1, 2016·The Annals of Pharmacotherapy·Gregory RobertsStephen Quinn
Apr 22, 2011·Journal of Pharmacy Practice·Pamela J White
Mar 10, 2011·The Annals of Pharmacotherapy·Leanne StaffordLuigi Gaetani
Jul 13, 2006·The Annals of Pharmacotherapy·Luke R BereznickiGregory M Peterson
Jan 13, 2018·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Logan M OlsonScott D Nei
Nov 26, 2011·Expert Review of Clinical Pharmacology·Gwendolyn A McMillinRobert C Pendleton
Jul 16, 2019·The Annals of Pharmacotherapy·Logan M OlsonScott D Nei
Dec 18, 2013·British Journal of Clinical Pharmacology·Anna-Karin HambergE Niclas Jonsson
Sep 27, 2012·American Journal of Therapeutics·Melanie L BorosJacob P Zimmerman
Apr 9, 2010·Clinical Pharmacology and Therapeutics·P LenziniB F Gage
Oct 27, 2018·Therapeutic Advances in Drug Safety·Karen TysonGreg Scutt
Aug 17, 2019·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Douglas D DeCarolisFatima B Khan

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